Monthly Teleconferences Research Articles

Translating Knowledge Into Clinical Practice: A Unique End-of-Life Nursing Education Consortium Teleconferencing Program.

For learning to influence change in palliative clinical practice, education needs to be ongoing, incorporating specific interventions targeted to the learner, in a format that enhances knowledge and networking. This novel, online, interactive, case-based educational offering provided a method to allow ongoing integration of palliative care principles for health care professionals who attended the End-of-Life Nursing Education Consortium/Open Medical Institute courses in Salzburg during 2019-2022. Eight monthly teleconferences based on challenging clinical cases allowed discussion between palliative care professionals from 9 countries, serving as a mechanism for deepening theoretical information, allowing incorporation of best practice into the clinical setting, and, ultimately, improving care for all with serious illness. Many of the challenges encountered providing palliative care are universal. Through case vignettes, the group has been able to offer specific interventions, advances in practice, and discussions of approaches toward family and other health care professionals to provide optimal care. The participants report that the opportunity to learn from and support peers in other countries has been a rewarding and emotionally uplifting experience. These discussions were highly rated by participants who strongly voiced that the interactions would change their clinical practice to positively impact patient care.

PEM Pandemic Pivot: A Hybrid Approach to Pediatric Emergency Medicine Training in Thailand Allows for COVID-era Flexibility.

Introduction:The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).Method:Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.Results:Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.Conclusion:The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.

Designing and implementing two facilitation interventions within the \u2018Facilitating Implementation of Research Evidence (FIRE)\u2019 study: a qualitative analysis from an external facilitators\u2019 perspective

BackgroundThe ‘Facilitating Implementation of Research Evidence’ study found no significant differences between sites that received two types of facilitation support and those that did not on the primary outcome of documented compliance with guideline recommendations. Process evaluation highlighted factors that influenced local, internal facilitators’ ability to enact the roles as envisaged. In this paper, the external facilitators responsible for designing and delivering the two types of facilitation intervention analyse why the interventions proved difficult to implement as expected, including the challenge of balancing fidelity and adaptation.MethodsQualitative data sources included notes from monthly internal-external facilitator teleconference meetings, from closing events for the two facilitation interventions and summary data analyses from repeated interviews with 16 internal facilitators. Deductive and inductive data analysis was led by an independent researcher to evaluate how facilitation in practice compared to the logic pathways designed to guide fidelity in the delivery of the interventions.ResultsThe planned facilitation interventions did not work as predicted. Difficulties were encountered in each of the five elements of the logic pathway: recruitment and selection of appropriate internal facilitators, preparation for the role, ability to apply facilitation knowledge and skills at a local level, support and mentorship from external facilitators via monthly teleconferences, working collaboratively and enabling colleagues to implement guideline recommendations. Moreover, problems were cumulative and created tensions for the external facilitators in terms of balancing the logic pathway with a more real-world, flexible and iterative approach to facilitation.ConclusionEvaluating an intervention that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. At a practical level, relational aspects of facilitation are critically important. It is essential to recruit and retain individuals with the appropriate set of skills and characteristics, explicit support from managerial leaders and accessible mentorship from more experienced facilitators. At a methodological level, there is a need for attention to the balance between fidelity and adaptation of interventions. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, informed by prospective use of process evaluation data and more detailed investigation of the context-facilitation dynamic.

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events.

Ventilator-associated events are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the National Institute of Health and Agency for Healthcare Research and Quality funded a two-state collaborative to reduce ventilator-associated events. We describe the collaborative's impact on ventilator-associated event rates in 56 ICUs. Longitudinal quasi-experimental study. Fifty-six ICUs at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. We organized a multifaceted intervention to improve adherence with evidence-based practices, unit teamwork, and safety culture. Evidence-based interventions promoted by the collaborative included head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care, and daily spontaneous awakening and breathing trials. Each unit established a multidisciplinary quality improvement team. We coached teams to establish comprehensive unit-based safety programs through monthly teleconferences. Data were collected on rounds using a common tool and entered into a Web-based portal. ICUs reported 69,417 ventilated patient-days of intervention compliance observations and 1,022 unit-months of ventilator-associated event data. Compliance with all evidence-based interventions improved over the course of the collaborative. The quarterly mean ventilator-associated event rate significantly decreased from 7.34 to 4.58 cases per 1,000 ventilator-days after 24 months of implementation (p = 0.007). During the same time period, infection-related ventilator-associated complication and possible and probable ventilator-associated pneumonia rates decreased from 3.15 to 1.56 and 1.41 to 0.31 cases per 1,000 ventilator-days (p = 0.018, p = 0.012), respectively. A multifaceted intervention was associated with improved compliance with evidence-based interventions and decreases in ventilator-associated event, infection-related ventilator-associated complication, and probable ventilator-associated pneumonia. Our study is the largest to date affirming that best practices can prevent ventilator-associated events.

Development and implementation of clinical pathways across a network of blood cancer programs.

161 Background: The Sarah Cannon Blood Cancer Network (SCBCN) is comprised of 7 blood cancer and Hematopoietic Cell Therapy (HCT) programs providing care for complex blood cancer patients. Network commitment to achieving standardization of care for quality and clinical platforms led to process design for development of evidence-based pathways. Methods: Standard operating procedures and a document control process were developed by the network quality management (QM). With oversight by physician leaders, initial efforts focused on standardizing patient selection criteria for HCT followed by formation of disease-specific work groups (leukemia, lymphoma, multiple myeloma, HCT). Physician-led and composed of key network team members (PharmDs, QM professionals, SCBCN leaders, research staff), the groups are responsible for developing evidence-based diagnostic and treatment pathways/algorithms for hematologic malignancies. Members participate in monthly teleconferences to develop the pathways. Annual review and deviation tracking are conducted, providing a mechanism for subsequent pathway revisions reflecting changing treatment paradigms and updated clinical evidence. QM oversees implementation and tracking across the network. Deviation tracking is managed locally using pathway-associated algorithms, with attending physician attestation to either compliance or pathway deviation/reason (e.g. co-morbidity, age, disease status, enrolled on clinical trial, other). Results are reported quarterly with review by QM. Results: See table. To date, 13 HCT pathways (18 algorithms) have been developed and released to SCBCN programs. Final approval is pending for 5 disease-based pathways (19 algorithms). Conclusions: The first compliance report will be submitted to QM in December, 2016. While deviation tracking has been paper-based, work efforts are underway to implement an electronic solution, enabling automated real-time monitoring. Implementation is expected in early 2017. [Table: see text]

L’évaluation par la simulation de la compétence des résidents an anesthésiologie: mise au point et mise en œuvre d’un Programme national de simulation en anesthésiologie au Canada (CanNASC)

The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force. The goals were to develop, implement, and evaluate a set of consensus-driven standardized mannequin-based simulation scenarios that every trainee must complete satisfactorily prior to completion of anesthesiology residency and certification. Curriculum development followed Kern's principles and was accomplished via monthly teleconferences and annual face-to-face meetings. The development and implementation processes included the following key elements: 1) Curriculum needs assessment: 368 of 958 invitees (38.4%) responded to a national survey resulting in 64 suggested scenario topics. Use of a modified Delphi technique resulted in seven important and technically feasible scenarios. 2) Scenario development: All scenarios have learning objectives from the National Curriculum for Canadian Anesthesiology Residency. Standardized scenario templates were created, and the content was refined and piloted. 3) Assessment: A validated Global Rating Scale (GRS) is the primary assessment tool, informed by using scenario-specific checklists (created via a modified Delphi technique) and the Anesthesia Non-Technical Skills GRS. 4) Implementation: Standardized implementation guidelines, pre-brief/debrief documents, and rater training videos, guide, and commentary were generated. National implementation of the scenarios and program evaluation is currently underway. It is highly feasible to achieve specialty-based consensus on the elements of a national simulation-based curriculum. Our process could be adapted by any specialty interested in implementing a simulation-based curriculum incorporating competency-based assessment on a national scale.

Implementing patient-centered care: Challenges in community oncology.

192 Background: The newest Commission on Cancer (CoC) standards focus on patient-centered care across the cancer continuum and include palliative care (PC) and psychosocial care (PS). Little is published regarding the challenges of implementing these standards in community oncology settings. To help examine the integration of PC and PS and to identify barriers and best practices, an assessment was conducted by sites selected to take part in the National Cancer Institutes’ Community Cancer Centers Project (NCCCP). Methods: The NCCCP’s goals to improve quality of care and reduce healthcare disparities included goals for expansion of PC and PS services. Volunteers formed workgroups using monthly teleconferences to share best practices and resources. A questionnaire based on the National Quality Forum (NQF) preferred practices was completed (January-April 2012) by 22 of 29 sites. Results: All respondents have inpatient PC available, 65% in the outpatient setting; 39% described PC as an integral part of their cancer program. All have designated outpatient staff providing symptom management and rehabilitation services. Nurse practitioners and physician assistants are used at 78% of the centers. Interdisciplinary staff includes pharmacists and dietitians; integrative/complementary medicine is found in 57% of the centers. All have integrated PS services: social workers are available in 91% of sites, 30% have psychiatrists, and 30% have psychologists. Most perform psychosocial screening using the NCCN Distress Management tool; 74% have standardized processes. Spiritual support is present in 70% of programs, sexual counseling services in 26%. The majority provides bereavement support. 48% have an outpatient advanced directive program. Inpatient hospice beds are available in 52% of the institutions and 22% own a hospice. Conclusions: Challenges remain with implementation of psychosocial screening and care. Programs to address sexual counseling and advanced directives are lacking. Additional efforts are needed to integrate PC services across the cancer continuum. Project funded with federal funds from the NCI, Contract No. HHSN261200800001E.

The Coach Is In: Improving Nutritional Care in Nursing Homes

This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff received step-by-step instructions for implementing an evidence-based nutritional management program. After each session, participants were asked to implement the care step they had just learned. Coaching calls helped facilitate implementation. Staff in 18 NHs in 12 states completed the course. Evaluation data were collected using a resident data form, pre- and post-training quizzes, a participant course evaluation survey, and a supervisor's report. NH staff attended an average of 4.8 teleconferences, with 5 staff members typically attending each teleconference. Average quiz scores increased 30% (p < .0001) from pre- to post-training. A majority of course participants (N = 35) said they would participate in a similar course (82.9%) and would recommend the course (80%). Just under half preferred the coaching course to a more traditional 1- to 2-day conference. Nine of 12 reporting supervisors said their facility planned to continue the new nutritional care program. The 10 NHs that submitted resident data assessed an average of 5 residents using the recommended protocols. We recommend the coaching course format. Dissemination outcomes may improve if resources currently used for short-duration training activities are used instead on coaching activities that support NHs over extended periods.

“Asia Pacific Allergy”: A new leap forward

Asia Pacific Allergy, the official journal of the Asia Pacific Association of Allergy, Asthma, and Clinical Immunology (APAAACI), celebrated its takeoff in a launching ceremony on November 6, 2010-a historic day for the new journal. Its first edition was released on April 30, 2011. Over the years, APAAACI has made remarkable progress with contributions from past presidents and members. It is now positioning itself as an allergy and clinical immunology organization representing the Asia Pacific region. During a discussion at the Executive Board Members's meeting in Singapore on July 19, 2009, it was suggested that the publication of an official journal would allow the APAACI to elevate its professional standing, and plans were immediately put into action. After finalizing details of the publication through monthly teleconferences, the launching of the journal was announced to Board Members and House of Delegate members on August 26, 2010. I would like to express my sincere appreciation to Prof. Connie H. Katelaris, President of APAAACI, and Prof. Pakit Vichyanond, former President of APAAACI, who had both stressed the necessity and significance of launching a journal and showed passionate enthusiasm during its initial stages. I also would like to thank the board members of APAAACI and the editorial board members of the Asia Pacific Allergy journal for their support and sending their precious manuscripts. The primary aim of the journal is to serve members of APAAACI by encouraging communication between allergy specialists, doctors, and allied health professionals in the Asia Pacific region. In the coming years, I believe that the journal will grow in influence and be shared by allergy experts around the world as well. In consideration of the situations of member societies, the first several editions of the journal will carry materials focusing on educational content. In the 21st century, the Internet has been used as a means of exchanging information both efficiently and rapidly, allowing allergy specialists and other professionals to easily exchange and obtain information on allergies. However, we must also assume grave responsibility for such information as it spreads to ensure accuracy in content. To take advantage of the wide reach of the Internet, the Asia Pacific Allergy Journal is basically available as an e-journal. We will send the table of contents via e-mail (eTOC). You may search and download articles at our website (www.apallergy.org) for free. Asia Pacific Allergy is an Open Access journal. The Asia Pacific Allergy journal will be also available as a paper journal if requested. In addition, for improved communication and understanding, the journal includes rational concepts related to diagnosis as well as management and educational materials. I anticipate that the number of original papers included in the journal will also continue to rise. I look forward to the day when Asia Pacific Allergy becomes a leading citation journal for allergy and clinical immunology in the Asia Pacific region. We are looking forward to meeting you through the issues of Asia Pacific Allergy journal to come.

Strategies for implementing emergency department pharmacy services: Results from the 2007 ASHP Patient Care Impact Program

Strategies proposed during a patient care impact program for implementing emergency department (ED) pharmacy services are described. In June 2007, the American Society of Health-System Pharmacists developed a patient care impact program entitled "Introducing an Emergency Department Pharmacist into Your Institution" to provide experiential training to practicing pharmacists seeking to establish ED services in their institutions. Under the guidance of four mentors, 19 pharmacists from a variety of practice settings, including community-based hospitals and academic and tertiary-care-based institutions, were selected for participation the six-month program. Participants were divided into two groups, and each group was assigned two mentors. During their initial meeting, participants identified anticipated challenges to implementation of pharmacy services in the ED and began to define strategies with their mentors for effectively managing the anticipated challenges. Each group participated in one-hour monthly teleconferences with their mentors. In addition to monthly teleconferences, participants regularly contacted their mentors for additional assistance and several visited their mentors' institutions. Participants developed job descriptions for an ED pharmacist, developed a rationale and justification for implementing pharmacy services in the ED, obtained approval and support from appropriate parties for the ED pharmacist's role, developed plans for introducing a pharmacist to the ED, and developed quality-assurance methods to monitor the effectiveness of the pharmacist's role. Despite the diversity in practice settings, participants of the program faced similar challenges in implementing ED pharmacy services at their institutions. Various strategies toward solutions to these challenges were shared among participants and mentors.